Intrathecal Meperidine versus intrathecal Fentanyl for prevention of shivering in lower limb orthopedic surgeries under spinal anesthesia: A randomized double-blind placebo-controlled trial

Abstract

Objective:Shivering is an unpleasant sensation for patients who undergoing spinal anesthesia. This randomized double-blind clinical trial study was designed to compare the effect of intrathecal fentanyl with intrathecal meperidine for prevention of shivering in lower limb orthopedic surgeries under spinal anesthesia.Methods:Ninety patients were randomly recruited to receive either 3 ml of 0.5% hyperbaric bupivacaine plus 20 μg of fentanyl (Group F), or 3 ml of 0.5% hyperbaric bupivacaine plus 0.2 mg/kg of meperidine (Group M), or 3 ml of 0.5% hyperbaric bupivacaine plus normal saline (Group S). The incidence and intensity of shivering were compared in three groups. Data were analyzed by analysis of variances, Mann–Whitney U-test followed by Chi-square test.Findings:There were not statistically differences in complications and side-effects between three groups. Total incidence of shivering was similar between Groups F and M (16.7% vs. 13.3% respectively, P = 0.72) whereas it was significantly different to Group S (43.3%) (P = 0.025 for Group F vs. S, and P = 0.011 for Group M vs. S). Also the intensity of shivering between Groups F and M was similar (P = 0.66), while it was significantly less in these groups compared to Group S (P = 0.013 and P = 0.004, respectively).Conclusion:Addition of fentanyl 20 μg or meperidine 0.2 mg/kg to 0.5% bupivacaine intrathecally significantly decreased the incidence of shivering in lower limb orthopedic surgeries. There was no significant difference between two drugs with this respect.

Comparison of the Effects of Intrathecal Meperidine and Morphine on Incidence and Intensity of Shivering After Caesarean Sections Under Spinal Anesthesia: A Randomized Controlled Trial

“…One of the known effects of intrathechal opioids is the prevention and treatment of postoperative shivering (3,5,7). However, the safety of this practice is not completely stabilized.…”

Evaluation the Effect of Intrathecally Fentanyl Added to Lidocaine on Interception of Shivering in Abdominal Hysterectomy: Randomized Clinical Trial

“…Intrathecal 0.2 mg/kg meperidine versus 20 µg intrathecal fentanyl for prophylaxis of shivering in lower limb orthopedic surgeries under spinal anesthesia, show that total incidence and intensity of shivering was similar between groups F and M [15].…”

The evaluation of effects two different doses of hydrocortisone on the intensity of perioperative shivering in elective surgery under spinal anesthesia: A double-blind randomized controlled trial study

“…The incidence of this condition varies between 6.3% and 66% depending on the type and duration of operation, anesthesia technique, and patient's age and gender[12345678910] and has minimum incidence to 40% in patients operation with spinal anesthesia. [1011] With regard to the incidence and clinical significance, shivering has been known as the sixth major problem among from 33 clinical cases with the low rate of morbidity in clinical anesthesiology.…”

“…We assumed the incidence of shivering in the case and control group 10% and 40%, respectively, due to previous studies[56] with respect to α =0.05 and β =0.2. We calculated 29 patients in each group as the sample size.…”

“…[123456] Some processes can lead to central hypothermia. General and regional anesthesia are the same and in both the distribution of heat is from the center to the initial process environment that in spinal and epidural, the process does not reach to the balance because the environmental vasoconstriction is lost and shivering and low temperature are produced by a small volume of muscles above the block level.…”